DE-access

We are six months into our wonderful electronic records system. It was touted to help increase our efficiency and to allow ease of patient care. The government even touted it as something that increases access to healthy care as it became so much more efficient.

Here is what we have found so far. It has decreased the numbers patients that can be see in a clinic by 30%. Even with that reduction, the clinic runs an extra hour and half longer. The actual time of patient contact, defined as listening, examining, and answering questions has been decreased by 50%.. We have had to hire 2 new assistants for every three doctors. We are told that it would improve our coding and because of this it would be cost neutral. As of today, it has decreased productivity and only added to overhead for a cost to the practice of 112k per physician.

9% of our staff have quit. Our practice is between 9 and 14% indigent care and 20% Medicaid. We are the only ones in the area that will see Medicaid patients. We have had to cut back so much we just don't have the time to see the amount of patients we did before, much less the ability to provide for those like Medicaid that cost more than we are paid.

On the good side, we are fairing far better than most of the other practices in the area. The biggest primary care group with over 500 docs is on their third system and having more problems than we are. The bad side, if you were counting on Obama-Care you are.. You are de-accessed to the healthcare system.

The TEMPLEt OF DOOM

I hate making people wait and I know they hate waiting for the doctor and no matter what we do we always run late. We have looked at every possible appointment template and no matter what it always seems to fail. It is especially worse this time of year when everyone has to update their insurance and or Medicare info. The first appointment is at 830, we try to make that a follow up, but of course they come to the office at 830, have to update all the information which takes 20 minutes and then it has to be entered into the computer so they dont even go back until after 900. You then go to see them for what was scheduled as a brief check up of the problem that you were consulted to take care of only to have them want you to check and look at something unrelated. Meanwhile the other patients are arriving and by some type of space-time wormhole, all arrive about the same time regardless of their actual appointment time. Now the waiting room is full, everybody is mad and doesnt want to wait. In comes someone who has an appointment tomorrow and wants to see if they can be worked in. Whne you finally get to see the patients, after you see them for what the appointment was for, they say " oh, by the way, I have this stange pain down my left arm now and then, but its worse when I go up stairs!"

Comes with the Job

There are many jobs where you can avoid certain circumstances or push the hard part off onto someone else. Many days, I wish I had one of those jobs. Instead, I have to be the one who walks into the waiting room and bring the parents into the consultation room to tell them that the frozen section shows the worst tumor possible and that it is rapidly fatal. You go into surgery for what seems like a routine thing, only to find out it is anything but. They were not expecting this kind of news, neither was I. You want to save them the grief, hide from the information, hope someone else has to bring the bad news, but you cant. It comes with the Job.